Provider Demographics
NPI:1336613322
Name:MIRSHAHI, KAMRAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:MIRSHAHI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6466 TIMBER LAKE TER
Mailing Address - Street 2:
Mailing Address - City:OVID
Mailing Address - State:NY
Mailing Address - Zip Code:14521-9750
Mailing Address - Country:US
Mailing Address - Phone:289-879-3880
Mailing Address - Fax:
Practice Address - Street 1:6466 TIMBER LAKE TER
Practice Address - Street 2:
Practice Address - City:OVID
Practice Address - State:NY
Practice Address - Zip Code:14521-9750
Practice Address - Country:US
Practice Address - Phone:289-879-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX013198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor